Resolution of Comorbidities, Safety and Efficacy of Greater Curvature Plication in Obese Patients.

Since the acceptance of surgical procedures to achieve a sustainable weight loss, many
different procedures has been tried with variable success. Among them , various gastric
restrictive procedures have evolved over the years but abandoned due to poor long term
weight loss, food intolerance or severe gastroesophageal reflux. Currently, laparoscopic
adjustable gastric band ( LAGB) and sleeve gastrectomy are being used with variable
acceptance and success. Laparoscopic gastric plication or laparoscopic greater curvature
plication ( LGCP) has recently been done as an alternative to the other restrictive
procedures. But the short and long term safety and efficacy outcomes of LGCP is not well
documented in current literature. American society of metabolic and bariatric surgery (
ASMBS) guidelines state that LGCP procedures should be considered investigational at this
time and should be performed under a study protocol with third party oversight (e.g. IRB) to
ensure continuous evaluation of patient safety and to review adverse events and outcomes.

A prospective nonrandomized study at Cleveland clinic suggested that a reduction in gastric
capacity can be achieved by way of plication of stomach and thereby achieving encouraging
weight loss. We intend to study this procedure as an alternative to LAGB or sleeve
gastrectomy for carefully selected patients. The objective of this study will be to
demonstrate feasibility , short term and long term safety and efficacy of LGCP . This will
be done by achieving gastric restriction by infolding of stomach and thereby achieving good
weight loss . The subjects will be followed up post operatively to observe the effect on the
comorbidities along with sustained weight loss. The inclusion and exclusion criteria ,
target population, duration of subject participation and primary endpoints will be defined
and all the data will be recorded per protocol.

Inclusion Criteria:

1. Subject is willing to give consent and comply with evaluation and treatment schedule;

2. 18 to 65 years of age (inclusive);

3. Have a BMI > 27 with one or more significant co-morbid medical conditions which are
generally expected to be improved, reversed, or resolved by weight loss. These
conditions may include but are not be limited to -

- Hyperlipidemia

- Type 2 diabetes

- Mild obstructive sleep apnea

- Hypertension

- Osteoarthritis of the hip or knee

4. Agree to refrain from any type of weight-loss drug (prescription or OTC) or elective
procedure that would affect body weight for the duration of the trial;

5. HbA1C < 11%

6. For subjects who have Type 2 diabetes, the anti-diabetic medication regimen is no
more complex than oral metformin plus one oral sulfonylurea plus once daily insulin
injection.

7. Ability to self pay for the procedure and follow up.

Exclusion Criteria:

1. Previous malabsorptive or restrictive procedures performed for the treatment of
obesity;

2. Scheduled concurrent surgical procedure, with the exception of SOC liver biopsy;

3. Women of childbearing potential who are pregnant or lactating at the time of
screening or at the time of surgery;

4. Any condition which precludes compliance with the study;

5. History or presence of pre-existing autoimmune connective tissue disease

6. Use of prescription or over the counter weight reduction medications or supplements
within thirty days of the Screening Visit or the duration of study participation.

7. Psychiatric disorders that may affect compliance with the clinical trial, including
dementia, active psychosis, severe depression requiring > 2 medications, or history
of suicide attempts. Any condition which places the subject at undue risk for the
procedure (surgeon's discretion).